Puncturing the Myth

Purinergic signaling, not mystical energy, may explain how acupuncture works.

By Geoffrey Burnstock | September 1, 2011

NATIONAL LIBRARY OF MEDICINE

According to traditional Chinese medical theory, acupuncture points are situated on meridians along which qi, the vital energy, flows. However, I have proposed a less mysterious neurophysiological mechanism to explain the beneficial effects of this 2,000-year-old practice (Medical Hypotheses, 73:470-72, 2009). In particular, my hypothesis is based on the surprising finding that a hitherto unknown extracellular signalling system exists between cells, including nerve cells.

Adenosine 5’-triphosphate (ATP) is well established as an intracellular energy source that powers biochemical processes. In 1972 I proposed that ATP has another biochemical role: it acts as an extracellular signalling molecule between cells. The messages carried by ATP are received on the surface of cells by specific receptors, which I termed purinoceptors, because ATP belongs to a group of chemicals known as purines. Six years later, two families of purinoceptors were identified—P1 receptors for adenosine, the breakdown product of ATP, and P2 receptors for ATP. The purinergic signaling concept was rejected by many for two decades. It wasn’t until the early 1990s, when the chemical and molecular structure of the plasma membrane receptors for ATP was characterized and other downstream members of this primitive signalling pathway were identified, that the concept of purinergic signalling between cells became widely accepted, and it is now a rapidly expanding field of physiological and pathophysiological study.

Two intriguing hints prompted me to consider that inserting and twisting a needle might release ATP from the skin and form the physiological basis for the effects of acupuncture: 1) Initially it was thought that the ATP acting as an extracellular signalling molecule was merely a by-product released when cells were damaged or dying. 2) A paper published 34 years ago reported that ATP injected into the human skin stimulated sensory neurons (Pain, 3:367-77, 1977).

It is now clear that ATP can be released from many cell types (e.g., osteoblasts and endothelial, epithelial, and glial cells) in response to gentle mechanical stimulation that does not damage the cells. ATP is also released in response to heat and electrical currents—techniques used today in conjunction with acupuncture to enhance its effect. Recent evidence has also confirmed the 1977 finding that sensory nerve terminals in the skin are activated by ATP. In this way, messages can be relayed from the skin via interneurons in the spinal cord to the brain stem. Furthermore, the well-established reduction of pain by acupuncture may be explained by the possibility that the binding of ATP to purinoceptors on sensory nerve endings in the skin activates a signaling pathway which ultimately modulates pain perception in the brain’s cortex. Acupuncture’s inhibition of pain may also involve the release of endorphins.

ACUPUNCTURE AND PURINERGIC SIGNALING Insertion and twisting of the needles employed in acupuncture mechanically deforms the skin, leading to the release of ATP by skin keratinocytes (1). ATP binds to specific receptors located on sensory nerve endings in the skin known as P2X3 and P2X2/3 (2). The signaling message is then relayed via dorsal root ganglia to the spinal cord (3) and subsequently through interneuronal pathways (4) to the brain stem (5) which contains motor neurons that control the functions of gut, lung, heart, arteries and reproductive organs, all major targets for acupuncture. Signals also travel to pain centers in the cortex, delivering a message to inhibit pain (6).

LUCY READING-IKKANDA

The ATP-activated sensory nerves also lead to modulation of the activity of brain-stem neurons controlling autonomic nervous system functions of gut, lung, urogenital, and cardiovascular systems—all of which have been treatment targets for traditional acupuncture procedures. There is published evidence for the release of ATP from keratinocytes, the major cell type in the skin, during mechanical stimulation. Similarly, ATP is released from urothelial cells lining the bladder and ureter in response to stretch, and receptors for ATP are present on suburothelial sensory nerves, ready to relay messages to the pain centers in the central nervous system. In addition, release of ATP in response to mechanical stimulation (changes in blood flow) from endothelial cells that line blood vessels leads to vasodilatation. And further, ATP is released from epithelial cells lining the airways in response to stretch, leading to activation of ATP receptors on sensory nerves, in turn resulting in the activation of reflexes that protect the lung against hyperventilation.

Immunohistochemical studies have shown that the specific ATP receptor subtypes, P2X3 and P2X2/3, are located on sensory nerve endings in the skin. The same subtypes are also especially abundant in the tongue, another site where acupuncture needles are placed. An isolated preparation of tongue tissue showed that the increased electrical activity in lingual general sensory nerves in response to mechanical stimulation could be mimicked by injecting ATP into the preparation and blocked by injecting antagonists to the P2X3 receptor subtype. The cell bodies of the sensory nerve endings that supply the skin are located in sensory ganglia, which then connect with neurons in the dorsal spinal cord. A series of interneurons then mediate modulatory pathways to the brain stem and hypothalamus, which are the nervous control centers for the activities of visceral organs. (See illustration.)

Suggested experiments

Many tools are available to test various aspects of this hypothesis experimentally. Apyrase, a readily available enzyme that breaks down ATP, could be applied to the skin to see whether the enzyme diminishes the benefits of acupuncture. In contrast, inhibitors of ATP breakdown, such as ARL-67156, could be employed to see whether this would enhance the beneficial effects of acupuncture. There are also very sensitive assay methods for measuring ATP release, which could be used in skin subjected to mechanical deformation, heat, and electrical current. Selected blockers (antagonists) of P2X3 and P2X2/3 receptors are available, which should block the beneficial effects of acupuncture. It seems likely from experiments on the bladder and intestine that ATP-sensitive low-threshold sensory fibers mediate physiological events, while high-threshold fibers mediate pain. This will need to be clarified for the sensory nerves supplying the skin and tongue before approaches to enhancing the ATP-related responses to acupuncture are carried out, in case the enhancement results in pain.

I hope that this hypothesis will provoke some scientists interested in acupuncture to investigate further.

Geoffrey Burnstock is Emeritus Professor and President of the Autonomic Neuroscience Centre of University College Medical School in London. He is editor-in-chief of Autonomic Neuroscience, Purinergic Signalling, and the journals Open Neuroscience and Open Pharmacology.

It may be considered offensive to anyone practicing acupuncture to refer to qi asÂ Â mystical energy. In fact Chinese medicine is a very pragmatic way of looking at and using the body's energies. Now we know them to be ATP but in ancient China they used their own words.Â Qi is energy and it has many forms which can be demonstrated.Â

It may be considered offensive to anyone practicing acupuncture to refer to qi asÂ Â mystical energy. In fact Chinese medicine is a very pragmatic way of looking at and using the body's energies. Now we know them to be ATP but in ancient China they used their own words.Â Qi is energy and it has many forms which can be demonstrated.Â

It may be considered offensive to anyone practicing acupuncture to refer to qi asÂ Â mystical energy. In fact Chinese medicine is a very pragmatic way of looking at and using the body's energies. Now we know them to be ATP but in ancient China they used their own words.Â Qi is energy and it has many forms which can be demonstrated.Â

Although Prof. Burnstock's discoveries are important, in this context he has missed the point: No well controlled clinical trial has _ever_ shown a positive effect of acupuncture. His comments will be seized by the charlatans who extract money from patients for treatments that do not work. Â His 'hypothesis' is misguided and inappropriate.

"In one of the largest clinical trials to date to test the safety and efficacy of acupuncture, NIH-supported researchers found that acupuncture significantly reduced pain associated with osteoarthritis of the knee when used as a complement to conventional therapy. Other studies and reviews demonstrated that acupuncture provides relief for vomiting and nausea from chemotherapy, shows possible effect for tension headaches, and that acupuncture and simulated acupuncture can both provide relief for those suffering from low-back pain."Source:Â http://report.nih.gov/NIHfacts...

It seems the editors -- or headline writers -- have inserted themselves to cast Mr. Burnstock's thesis as somehow discrediting, rather than supporting, the validity of acupuncture. Clearly, his article suggests a mechanism to explain acupuncture's effects, particularly on pain. The headline writer seems uncomfortable with this line of investigation, and so disparages acupuncture as resting on 'myth' and 'mystical energy,' which figure nowhere in Mr. Burnstock's commentary.

As if conventional -- Western -- treatments did not themselves arise from mysterious origins!

Acupuncture just placebo? NIH doesn't seem to agree:http://report.nih.gov/NIHfacts..."In one of the largest clinical trials to date to test the safety and efficacy of acupuncture, NIH-supported researchers found that acupuncture significantly reduced pain associated with osteoarthritis of the knee when used as a complement to conventional therapy. Other studies and reviews demonstrated that acupuncture provides relief for vomiting and nausea from chemotherapy, shows possible effect for tension headaches, and that acupuncture and simulated acupuncture can both provide relief for those suffering from low-back pain."

The article is the same as the one Prof Burnstock published in 2009Medical Hypotheses Volume 73, Issue 4, October 2009, Pages 470-472 Acupuncture: A novel hypothesis for the involvement of purinergic signallingIn 2010 Goldman et al publish an interesting paper on the same topic.Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncturein Nature Neuroscience Nature Neuroscience 13, 883-888. DOI:doi:10.1038/nn.2562 Acupuncture on knockout mice!

The NIH has evaluated acupuncture:http://report.nih.gov/NIHfacts..."In one of the largest clinical trials to date to test the safety and efficacy of acupuncture, NIH-supported researchers found that acupuncture significantly reduced pain associated with osteoarthritis of the knee when used as a complement to conventional therapy. Other studies and reviews demonstrated that acupuncture provides relief for vomiting and nausea from chemotherapy, shows possible effect for tension headaches, and that acupuncture and simulated acupuncture can both provide relief for those suffering from low-back pain."

One can forgive Prof. Burnstock for missing the article by Goldman, alia et Nedergaard (Nat Neurosci. 13:883-8, 2010, that appeared after his original publication. Nonetheless, I would like to hear his impressions of those findings that implicate adenosine rather than ATP in acupuncture induced antinociception. Adenosine is, of course, a break down product of ATP

It is not a "fact" that acupuncture has been practice on animals for 3,000 years.Â The modern practice (fine needles, at points) is an invention of the mid-20th century, and there's still no good evidence that it does anything.Â As for mechanisms, you can sometimes get endorphins to rise by sticking needles in horses; you can also get them to rise by putting them in a horse trailer, and taking them for the ride.Â Come to think of it, that's a "tradition" that's been followed in horses for longer than acupuncture!Â Â David Ramey, DVM

The suggested mechanism still does not provide an explanation or a reason for major difference between some very localized points (the acupuncture points) and any arbitrary point of the skin surface. Hence, while bringing to light an interesting general signaling pathway, theÂ ATP extracellular signalling effectÂ cannot yet be taken as advancing a scientific explanation of the principle characteristics of the acupuncture phenomenon (assumed to be real for the sake of the argument).Â Â

"For the first time, a clinical trial with sufficient rigor, size, and duration has shown that acupuncture reduces the pain and functional impairment of osteoarthritis of the knee," said Stephen E. Straus, M.D. NCCAM Director. (National Center for Complementary and Alternative Medicine (NCCAM). Â http://www.nih.gov/news/pr/dec...Now, how it works? on the brain: â€œâ€¦the NCCAM has funded extensive research to advance scientific understanding of acupuncture. Someâ€¦studies have looked at:â€œHow acupuncture might work, such as what happens in the brain during acupuncture treatmentâ€쳌 http://nccam.nih.gov/health/ac...â€œHypothalamus and amygdala response to acupuncture stimuli in carpal tunnel syndrome. Â http://www.painjournalonline.c...A Harvard Martinos research: â€œNeuroimaging Acupuncture Effects on Human Brain Activity.Â http://www.nmr.mgh.harvard.edu...

Although Prof. Burnstock's discoveries are important, in this context he has missed the point: No well controlled clinical trial has _ever_ shown a positive effect of acupuncture. His comments will be seized by the charlatans who extract money from patients for treatments that do not work. Â His 'hypothesis' is misguided and inappropriate.

"In one of the largest clinical trials to date to test the safety and efficacy of acupuncture, NIH-supported researchers found that acupuncture significantly reduced pain associated with osteoarthritis of the knee when used as a complement to conventional therapy. Other studies and reviews demonstrated that acupuncture provides relief for vomiting and nausea from chemotherapy, shows possible effect for tension headaches, and that acupuncture and simulated acupuncture can both provide relief for those suffering from low-back pain."Source:Â http://report.nih.gov/NIHfacts...

It seems the editors -- or headline writers -- have inserted themselves to cast Mr. Burnstock's thesis as somehow discrediting, rather than supporting, the validity of acupuncture. Clearly, his article suggests a mechanism to explain acupuncture's effects, particularly on pain. The headline writer seems uncomfortable with this line of investigation, and so disparages acupuncture as resting on 'myth' and 'mystical energy,' which figure nowhere in Mr. Burnstock's commentary.

As if conventional -- Western -- treatments did not themselves arise from mysterious origins!

Acupuncture just placebo? NIH doesn't seem to agree:http://report.nih.gov/NIHfacts..."In one of the largest clinical trials to date to test the safety and efficacy of acupuncture, NIH-supported researchers found that acupuncture significantly reduced pain associated with osteoarthritis of the knee when used as a complement to conventional therapy. Other studies and reviews demonstrated that acupuncture provides relief for vomiting and nausea from chemotherapy, shows possible effect for tension headaches, and that acupuncture and simulated acupuncture can both provide relief for those suffering from low-back pain."

The article is the same as the one Prof Burnstock published in 2009Medical Hypotheses Volume 73, Issue 4, October 2009, Pages 470-472 Acupuncture: A novel hypothesis for the involvement of purinergic signallingIn 2010 Goldman et al publish an interesting paper on the same topic.Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncturein Nature Neuroscience Nature Neuroscience 13, 883-888. DOI:doi:10.1038/nn.2562 Acupuncture on knockout mice!

The NIH has evaluated acupuncture:http://report.nih.gov/NIHfacts..."In one of the largest clinical trials to date to test the safety and efficacy of acupuncture, NIH-supported researchers found that acupuncture significantly reduced pain associated with osteoarthritis of the knee when used as a complement to conventional therapy. Other studies and reviews demonstrated that acupuncture provides relief for vomiting and nausea from chemotherapy, shows possible effect for tension headaches, and that acupuncture and simulated acupuncture can both provide relief for those suffering from low-back pain."

One can forgive Prof. Burnstock for missing the article by Goldman, alia et Nedergaard (Nat Neurosci. 13:883-8, 2010, that appeared after his original publication. Nonetheless, I would like to hear his impressions of those findings that implicate adenosine rather than ATP in acupuncture induced antinociception. Adenosine is, of course, a break down product of ATP

It is not a "fact" that acupuncture has been practice on animals for 3,000 years.Â The modern practice (fine needles, at points) is an invention of the mid-20th century, and there's still no good evidence that it does anything.Â As for mechanisms, you can sometimes get endorphins to rise by sticking needles in horses; you can also get them to rise by putting them in a horse trailer, and taking them for the ride.Â Come to think of it, that's a "tradition" that's been followed in horses for longer than acupuncture!Â Â David Ramey, DVM

The suggested mechanism still does not provide an explanation or a reason for major difference between some very localized points (the acupuncture points) and any arbitrary point of the skin surface. Hence, while bringing to light an interesting general signaling pathway, theÂ ATP extracellular signalling effectÂ cannot yet be taken as advancing a scientific explanation of the principle characteristics of the acupuncture phenomenon (assumed to be real for the sake of the argument).Â Â

"For the first time, a clinical trial with sufficient rigor, size, and duration has shown that acupuncture reduces the pain and functional impairment of osteoarthritis of the knee," said Stephen E. Straus, M.D. NCCAM Director. (National Center for Complementary and Alternative Medicine (NCCAM). Â http://www.nih.gov/news/pr/dec...Now, how it works? on the brain: â€œâ€¦the NCCAM has funded extensive research to advance scientific understanding of acupuncture. Someâ€¦studies have looked at:â€œHow acupuncture might work, such as what happens in the brain during acupuncture treatmentâ€쳌 http://nccam.nih.gov/health/ac...â€œHypothalamus and amygdala response to acupuncture stimuli in carpal tunnel syndrome. Â http://www.painjournalonline.c...A Harvard Martinos research: â€œNeuroimaging Acupuncture Effects on Human Brain Activity.Â http://www.nmr.mgh.harvard.edu...

Although Prof. Burnstock's discoveries are important, in this context he has missed the point: No well controlled clinical trial has _ever_ shown a positive effect of acupuncture. His comments will be seized by the charlatans who extract money from patients for treatments that do not work. Â His 'hypothesis' is misguided and inappropriate.

"In one of the largest clinical trials to date to test the safety and efficacy of acupuncture, NIH-supported researchers found that acupuncture significantly reduced pain associated with osteoarthritis of the knee when used as a complement to conventional therapy. Other studies and reviews demonstrated that acupuncture provides relief for vomiting and nausea from chemotherapy, shows possible effect for tension headaches, and that acupuncture and simulated acupuncture can both provide relief for those suffering from low-back pain."Source:Â http://report.nih.gov/NIHfacts...

It seems the editors -- or headline writers -- have inserted themselves to cast Mr. Burnstock's thesis as somehow discrediting, rather than supporting, the validity of acupuncture. Clearly, his article suggests a mechanism to explain acupuncture's effects, particularly on pain. The headline writer seems uncomfortable with this line of investigation, and so disparages acupuncture as resting on 'myth' and 'mystical energy,' which figure nowhere in Mr. Burnstock's commentary.

As if conventional -- Western -- treatments did not themselves arise from mysterious origins!

Acupuncture just placebo? NIH doesn't seem to agree:http://report.nih.gov/NIHfacts..."In one of the largest clinical trials to date to test the safety and efficacy of acupuncture, NIH-supported researchers found that acupuncture significantly reduced pain associated with osteoarthritis of the knee when used as a complement to conventional therapy. Other studies and reviews demonstrated that acupuncture provides relief for vomiting and nausea from chemotherapy, shows possible effect for tension headaches, and that acupuncture and simulated acupuncture can both provide relief for those suffering from low-back pain."

The article is the same as the one Prof Burnstock published in 2009Medical Hypotheses Volume 73, Issue 4, October 2009, Pages 470-472 Acupuncture: A novel hypothesis for the involvement of purinergic signallingIn 2010 Goldman et al publish an interesting paper on the same topic.Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncturein Nature Neuroscience Nature Neuroscience 13, 883-888. DOI:doi:10.1038/nn.2562 Acupuncture on knockout mice!

The NIH has evaluated acupuncture:http://report.nih.gov/NIHfacts..."In one of the largest clinical trials to date to test the safety and efficacy of acupuncture, NIH-supported researchers found that acupuncture significantly reduced pain associated with osteoarthritis of the knee when used as a complement to conventional therapy. Other studies and reviews demonstrated that acupuncture provides relief for vomiting and nausea from chemotherapy, shows possible effect for tension headaches, and that acupuncture and simulated acupuncture can both provide relief for those suffering from low-back pain."

One can forgive Prof. Burnstock for missing the article by Goldman, alia et Nedergaard (Nat Neurosci. 13:883-8, 2010, that appeared after his original publication. Nonetheless, I would like to hear his impressions of those findings that implicate adenosine rather than ATP in acupuncture induced antinociception. Adenosine is, of course, a break down product of ATP

It is not a "fact" that acupuncture has been practice on animals for 3,000 years.Â The modern practice (fine needles, at points) is an invention of the mid-20th century, and there's still no good evidence that it does anything.Â As for mechanisms, you can sometimes get endorphins to rise by sticking needles in horses; you can also get them to rise by putting them in a horse trailer, and taking them for the ride.Â Come to think of it, that's a "tradition" that's been followed in horses for longer than acupuncture!Â Â David Ramey, DVM

The suggested mechanism still does not provide an explanation or a reason for major difference between some very localized points (the acupuncture points) and any arbitrary point of the skin surface. Hence, while bringing to light an interesting general signaling pathway, theÂ ATP extracellular signalling effectÂ cannot yet be taken as advancing a scientific explanation of the principle characteristics of the acupuncture phenomenon (assumed to be real for the sake of the argument).Â Â

"For the first time, a clinical trial with sufficient rigor, size, and duration has shown that acupuncture reduces the pain and functional impairment of osteoarthritis of the knee," said Stephen E. Straus, M.D. NCCAM Director. (National Center for Complementary and Alternative Medicine (NCCAM). Â http://www.nih.gov/news/pr/dec...Now, how it works? on the brain: â€œâ€¦the NCCAM has funded extensive research to advance scientific understanding of acupuncture. Someâ€¦studies have looked at:â€œHow acupuncture might work, such as what happens in the brain during acupuncture treatmentâ€쳌 http://nccam.nih.gov/health/ac...â€œHypothalamus and amygdala response to acupuncture stimuli in carpal tunnel syndrome. Â http://www.painjournalonline.c...A Harvard Martinos research: â€œNeuroimaging Acupuncture Effects on Human Brain Activity.Â http://www.nmr.mgh.harvard.edu...

"For the first time, a clinical trial with sufficient rigor, size, and duration has shown that acupuncture reduces the pain and functional impairment of osteoarthritis of the knee," said Stephen E. Straus, M.D. NCCAM Director. (National Center for Complementary and Alternative Medicine (NCCAM). Â http://www.nih.gov/news/pr/dec...

â€œTreatment outcomes for migraine do not differ between patients treatedwith sham acupuncture, verum acupuncture, or standard therapy"They do work.Â I see that you neither Sham99 read the document. ???

â€œTreatment outcomes for migraine do not differ between patients treatedwith sham acupuncture, verum acupuncture, or standard therapy"They do work.Â I see that you neither Sham99 read the document. ???

"For the first time, a clinical trial with sufficient rigor, size, and duration has shown that acupuncture reduces the pain and functional impairment of osteoarthritis of the knee," said Stephen E. Straus, M.D. NCCAM Director. (National Center for Complementary and Alternative Medicine (NCCAM). Â http://www.nih.gov/news/pr/dec...

â€œTreatment outcomes for migraine do not differ between patients treatedwith sham acupuncture, verum acupuncture, or standard therapy"They do work.Â I see that you neither Sham99 read the document. ???

"For the first time, a clinical trial with sufficient rigor, size, and duration has shown that acupuncture reduces the pain and functional impairment of osteoarthritis of the knee," said Stephen E. Straus, M.D. NCCAM Director. (National Center for Complementary and Alternative Medicine (NCCAM). Â http://www.nih.gov/news/pr/dec...

Interestingly the comments by "scientists" show many of us, that instead of having a broad mind open to full investigation of a hypothesis and testing it and then making a well informed comment, they show us that they are not true scientists according to the following definition:-

A person who studies or practises any of the science or who uses scientific method.

None of these "scientists" have either validated or otherwise their words (frequently misspelled). It is their archaic and blind prejudice which fails them as true scientists-Â

I challenge these so called "scientists " to first attempt to propose a hypothesis to disprove their theories in a proper scientific manner before opening their mouths.As both a Western trained and Western treating medical practitioner and acupuncturist, I find that acupuncture has a role in my practice and yes.....it does work for many conditions, that Western Medicine has failed to assist with. I use both laser and needles in my treatment of some patients. Perhaps, some of the cynics, should try it..all in the name of science. I find sceptics are the best to treat because the placebo effect is decreased in them. I dare any of you to try it...if it doesn't work for you, at least you can say "It did not work for me". You still cannot say it does not work until you have trialled a large number of people. All you can say is it did not work for you ,as an individual If it does, then investigate further and do not rubbish an idea before you have scientifically investigated a hypothesis. Let's face it, if you lived in 200 BCE you possibly did not realise the world was round, did you?

My response was not published but recent review work challenges those findings. Check Edzard Ernst Meta-analise. It shows that for anything else but neck pain acupuncture is not cientific supported. Its the greatest meta analise. You are just cherrypinking. There are a lot more studies not supporting acupuncture. There are also studies not supporting acupuncure for oesteoatritis and you can find one at the cochrane librari.

NCCAM is a scam. Any area of cience must prove itself before being admitted to self regulation.

PS: I will not post any links since my last coment was not published and I think its still under moderation because of a link to "Pain".

Not only that, you don't need to really stick them. Studies have shown that you just have to "tease" with a toothpick. Hilarius. Its nor meridians and other crap that is in steak here. Is some inexpecific reaction to personal atention and skin stimulation. Grooming should be tested next.

Not only that, you don't need to really stick them. Studies have shown that you just have to "tease" with a toothpick. Hilarius. Its nor meridians and other crap that is in steak here. Is some inexpecific reaction to personal atention and skin stimulation. Grooming should be tested next.

My response was not published but recent review work challenges those findings. Check Edzard Ernst Meta-analise. It shows that for anything else but neck pain acupuncture is not cientific supported. Its the greatest meta analise. You are just cherrypinking. There are a lot more studies not supporting acupuncture. There are also studies not supporting acupuncure for oesteoatritis and you can find one at the cochrane librari.

NCCAM is a scam. Any area of cience must prove itself before being admitted to self regulation.

PS: I will not post any links since my last coment was not published and I think its still under moderation because of a link to "Pain".